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D12-014 – Procedure

September 12, 2012

|TO: |Regional Administrators |

| |Field Services Administrators |

| |Case Management Supervisors |

| |Case Resource Managers |

| |VPS Supervisors and Social Workers |

|FROM: |Linda Rolfe, Director, Division of Developmental Disabilities |

|SUBJECT: |CHILDREN’S LONG-TERM INPATIENT PROGRAMS (CLIP) |

|Purpose: |To inform staff of the service description, application, payment, and appeal process for a child/youth |

| |applying for access into Children’s Long-term Inpatient Program (CLIP). |

|Background: |To date, there has been little communication regarding access to CLIP for DDD Children’s Case Resource |

| |Managers (CRM) and Voluntary Placement Services (VPS) Social Workers (SW). |

|What’s new, changed, or Clarified |CLIP is an intensive inpatient psychiatric treatment available to all Washington State residents, age 5 |

| |through 17 years. It provides individualized treatment through the use of evidenced based practices |

| |designed to increase the youth's skills and adaptive functioning with a focus on reintegration to a |

| |community setting. See the CLIP website to learn more: . |

| | |

| |CLIP does not provide an acute inpatient response. |

| | |

| |Acute psychiatric inpatient treatment is provided in a community hospital or a certified freestanding |

| |Evaluation and Treatment facility (E&T facility) when a child or adolescent is in need of immediate |

| |inpatient mental health services due to the acuity of their mental illness. |

| | |

| |For publicly funded acute hospitalization, a medical necessity determination is made by the RSN/PHP or |

| |Designated Mental Health Professional (DMHP). |

| | |

| |For privately funded acute hospitalization, the family's insurance company makes that determination. The|

| |length of stay in the hospital is variable, depending upon the child's needs. |

| | |

| |Involuntary Treatment: |

| | |

| |Under Washington State's juvenile mental health services law (Chapter 71.34 RCW) adolescents age 13 |

| |through 17 years may be committed for up to 180 days of involuntary inpatient psychiatric treatment. |

| |Under 180 day restrictive court order, the adolescent becomes eligible for admission to a CLIP Program. |

| |The adolescent's name is placed on the statewide waiting list as of the day of the 180 day restrictive |

| |ITA order. |

| | |

| |Adolescents committed for 180 days of involuntary inpatient treatment have been determined to meet |

| |medical necessity through the detention and commitment process as defined in RCW 71.34.750. |

| | |

| |Voluntary Treatment: |

| | |

| |The CLIP Administration makes determination of medical necessity for voluntary long-term inpatient care |

| |regardless of whether the child has public or private insurance. |

|ACTION: |Effective October 1, 2012, Field Services staff will use the following information when considering CLIP|

| |treatment for children/youth: |

| | |

| |Step 1: |

| | |

| |CRMs and VPS SWs must verify that the following eligibility criteria is met prior to submitting a |

| |voluntary CLIP application: |

| | |

| |Client is age 5 through 17 years and is a legal resident of Washington State. |

| | |

| |Client has been diagnosed with a severe psychiatric disorder (see CLIP website for full description) |

| |which significantly impacts their ability to function safely and adaptively in a community setting, and |

| |requires the intensity and restrictiveness provided by a CLIP Program. |

| | |

| |Due to the nature of the psychiatric impairment, the client possesses a risk to themselves, others or is|

| |gravely disabled which warrants care under the supervision of a psychiatrist, whose treatment needs |

| |cannot be met by community based, less restrictive resources and would benefit from an extended |

| |inpatient course of treatment. |

| | |

| |Clients age 13 years of age and older must agree to enter a CLIP Program. A CLIP Program does not have |

| |the right to hold youth in treatment against their will unless they are admitted in accord with RCW |

| |71.34 or ordered for short term evaluation under RCW 10.77. |

| | |

| |Step 2: |

| | |

| |The Regional Support Network (RSN) is responsible for providing the application and facilitating the |

| |local process of review. The DDD CRM/SW will assist in obtaining the following information to provide |

| |a completed application: |

| | |

| |Psychosocial History: Psychosocial history should include family, cultural, and social history; |

| |developmental and educational history; current medical information; psychiatric, substance abuse and |

| |residential treatment history; legal history; and custody and citizenship history (if applicable). |

| | |

| |Psychiatric Evaluation: An application must include a written report of an evaluation completed by a |

| |child/youth psychiatrist (MD) or ARNP within the six months prior to CLIP review. The report must |

| |include the physician’s or ARNP’s name, date of assessment, a DSM diagnostic classification on all five |

| |axes, a mental status examination, and a Comprehensive Assessment of the treatment needs of the |

| |applicant. |

| | |

| |Supporting Documentation: Supporting source documentation of the applicant’s needs is required. |

| |Supporting documents can include school records, medical reports, discharge summaries from previous |

| |treatment facilities, IQ testing, copies of relevant court orders, and other evaluations. |

| | |

| |Authorization to Release: Youth over the age of 13 and their parent/guardian are required by law to |

| |consent to release of information as well as voluntary participation in the CLIP treatment. All consent|

| |forms must be signed and submitted to the RSN with the completed application. |

| | |

| |Step 3: |

| | |

| |After the CLIP application is submitted, the RSN Children’s Care Coordinator will schedule a local CLIP |

| |review. |

| | |

| |If approved locally, the CLIP Application will be forwarded to the CLIP Administration for review and |

| |determination. |

| | |

| |If approved by the CLIP Administration, the child/youth will be assigned for admission to a CLIP Program|

| |and their name will be placed on the CLIP waiting list. This assignment process will be completed in |

| |collaboration with the family, the RSN treatment team, and the CLIP coordinator. |

| | |

| |If not approved, the CRM/SW and/or family may request a meeting to discuss the appeal process of a local|

| |review decision. |

| | |

| | |

|Related REFERENCES: |RCW 71.34.750 |

| |RCW 71.34.020(12) |

| | |

|ATTACHMENT(S): |None |

|CONTACT(S): |Nichole Jensen, DDD Program Manager |

| |360-725-3403 |

| |Nichole.Jensen@dshs. |

| | |

| |Lin Payton, DBHR Program Administrator |

| |360-725-1632 |

| |Lin.Payton@dshs. |

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